Clinical Reasoning: An 82-year-old man with worsening gait

Abstract

An 82-year-old man with hypothyroidism presented with difficulty walking.One year prior to presentation, he noticed that his legs occasionally "froze" when initiating walking. His gait progressively worsened over the year. He developed balance difficulty, tripping and falling twice without loss of consciousness. In the 4 months prior to presentation, he started using a cane, a rolling walker, then a wheelchair. He reported occasional neck and left leg cramps. He denied bowel or bladder symptoms.The patient was previously healthy, playing competitive sports at the national level into his late 70s. His only medication was levothyroxine.Question for consideration:1. What examination findings would help to localize the etiology of his abnormal gait?GO TO SECTION 2